Title: Pediatric and Family Disaster Planning
1Pediatric and Family Disaster Planning
Considerations for Emergency Managers
Lou Romig MD, FAAP, FACEP Miami Childrens
Hospital FL-5 DMAT/MSRT South
2No excuses!
- Children are involved directly or indirectly in
the great majority of disasters and multicasualty
incidents
3Small problems become big problems when they
involve our children
4When in danger, when in doubt, run in circles,
scream and shout.
5"Where in the hell is the cavalry on this one?''
Kate Hale, 8/27/92, Dade County Emergency Manager
6Y.O.Y.O
7Youre On Your Own
- The majority of disasters generate fewer than 50
injuries. Most of those are not critical. The
cavalry will not be coming! - Even if the feds are coming, its going to take
time.
8Key Concept
- Pediatric disaster planning at all levels and for
all hazards must be family-centered
9Who are emergency managers?
YOU ARE!
10Emergency Managers Goals
- Facilitate family preparedness and independence
- Reunite and keep families together
- Assure the provision of appropriate sheltering
and care before, during, and after an incident - Meet the needs of families with special
healthcare challenges - Work with other community agencies and
organizations to prepare for family care
11Facilitating Family Preparedness
- Provide a realistic and honest community risk
assessment - Publicize and furnish family preparedness tools
via internet, brochures, health fairs, media,
etc. - Work with school systems to distribute education
and information - Work with healthcare agencies and resource
suppliers to assist families with CSHCN in their
disaster planning
12Keeping families together
- Work with school systems on reunification plans
(shelter in place?) - Emphasize need for reunification planning at a
family level - Plan shelters so that families can stay together,
especially those with special medical needs - Work with medical facilities and EMS/Law
Enforcement to promote information sharing for
locating victims
13Adequate Care and Sheltering
14Adequate Care and Sheltering
- Special needs sheltering
- Shelter staff training and resources
- Safety
- Nutrition
- Waste disposal
- Infectious diseases
- Child care
- Stress management
15Special Needs Sheltering
- Keep families together!
- Community shelters or hospitals?
- Mix children with adults?
- Expanded definition of special needs
- Pediatric-specific medical and nutritional
supplies - Pediatric protocols/training for professional
caregivers
16Staff Training and Resources
- Who will staff regular and special needs
shelters? - Who can or should be turned away from regular
shelters? - Pediatric training? What level?
- Pediatric protocols for care or medical referral
- Reference materials
- Resources for phone or other advice
- Shelter sick call?
17Shelter Safety
- Childproof your shelters (hazmats, trip hazards,
etc.) - Protect frail elderly or others from rambunctious
children - Attempt to assure security of all medications
- Smoking, weapons, alcohol, drug policies
18Nutrition/Waste Disposal
- Assure provision of age-appropriate food and
drinks and availability of snacks - Watch choking hazards!
- Disposal of diapers, wipes,etc.
- Biohazard disposal (diabetic needles and lancets,
wound dressings, etc.)
19Infectious Diseases
- Screening at time of shelter entry
- How to handle new onset illnesses
- Medical isolation/segregation within the shelter
- When to involve Public Health
- Assessment of at-risk populations (elderly,
potentially immuno-compromised occupants) - Need for passive immunization (ex VZIG)
20Child Care
21Stress Management
- Mental health professionals with child/family
training - Information, information, information
- Provide energy outlets for kids
- Provide parents with time away from kids
- Provide best possible sleep environment
- Therapeutic play (drawing, role play)
22Jonathan, age 6, Hurricane Lili
Tree breaking
Rain
Scared Jonathan
23Emergency Managers Goals
- Facilitate family preparedness and independence
- Reunite and keep families together
- Assure the provision of appropriate sheltering
and care before, during, and after an incident - Meet the needs of families with special
healthcare challenges - Work with other community agencies and
organizations to prepare for family care
24Families with CSHCN
- Whos out there? (families, daycare and
residential facilities) - Liaison with EMS (Emergency Information Form from
AAP/ACEP) - Assist families and facilities with disaster
planning - Family-centered sheltering
- Emergency supply resources
25Planning Partnerships
26Planning Partners
- Emergency managers/planners
- Emergency responders
- Community response organizations
- School and childcare systems
- Medical facilities and practitioners, including
mental health professionals - Families and family organizations
27Emergency Responders
- Work to assure that local responders can deal
with the daily emergency needs of children and
families.
Disaster work is the same as everyday work, just
more intense, more chaotic, more stressful and
just plain more
28Emergency Responders
- Disaster Training
- Pediatric threat-specific risks
- Pediatric assessment
- Pediatric MCI triage
- Pediatric treatment
- Pediatric decontamination
29Emergency Responders
- Disaster Training (cont)
- Appropriate transport modes and destinations
- Communication skills
- Stress management
- Reference resources
30Emergency Responders
- Pediatric specific equipment
- Protocols
- Pediatric drug preparations and delivery systems
(Atropen, CWIK tool)
www.cwikresponse.com
31Emergency Responders
- Special attention to CSHCN
- Medicolegal aspects (children without guardians)
- Disaster documentation
- Awareness of local family reunification schemes
32Community Responders
- Help to assure that local volunteer responders
(such as CERT members) receive pediatric training - Monitor NGO plans for inclusion of consideration
of family issues
33School and Childcare Systems
- Work with public and private school systems in
their disaster planning - Help schools integrate with local response
systems - Provide risk assessments to schools and childcare
facilities - Establish minimum standards for disaster/disaster
planning training for all licensed childcare
workers and school systems?
34Medical Facilities and Practitioners
- Increase practitioner awareness of the need for
personal, family and office/facility disaster
planning. - Encourage medical practitioners to assist their
patients with family disaster planning. - Encourage practitioners to become disaster
responders (Citizen Corps, Medical Reserve Corps)
35Medical Facilities and Practitioners
- Help to assure that pediatric issues are
addressed in all fixed medical facility disaster
plans and drills - Help hospitals integrate into community disaster
response plans (incident management structure,
communications, field response, responsibility
for care of unusual pediatric patient loads)
36Â IS 700 - National Incident Management System
(NIMS), An Introduction
- US Fire Academy
- Emergency Management Institute
- http//training.fema.gov/EMIWEB/IS/is700.asp
37Mental Health Professionals
- Key players in emergency planning and response
- Help to anticipate community reactions and
behaviors - Assist with proactive education to mitigate
mental health complications after disasters - Provide individual and system-level guidance
after a disaster - Must include pediatric and family considerations
38Families and Family Organizations
- Incorporate family representatives and advocates
in the community planning process - Encourage family advocates to champion family
disaster preparedness - Listen and learn from families
39Emergency Managers Goals
- Facilitate family preparedness and independence
- Reunite and keep families together
- Assure the provision of appropriate sheltering
and care before, during, and after an incident - Meet the needs of families with special
healthcare challenges - Work with other community agencies and
organizations to prepare for family care
40Feeling a little overwhelmed?
41Planning for Kids and Terrorism
42Kids and Terrorism
- It has happened. It will happen again.
- Children are soft targets for hard-core
terrorists. - Very few are really ready to protect and care for
children in a hazmat incident, much less a WMD
setting.
43Kids and Terrorism
- Assess your communities for terrorist risk, with
a special eye toward large family-oriented
gathering places and venues where large numbers
of children are usually found. - Look at the community composition around major
potential target sites. Are there residential
areas, schools, hospitals nearby?
44Kids and Terrorism
- Help families assess their own risks of being
involved in a terrorist incident - As victims, direct or indirect
- As responders
- Help them plan accordingly.
45Kids and Terrorism
- Provide information in the form of facts, not
speculation. - Dont ignore the issue of terrorism and disaster
preparedness in community outreach programs and
schools. Information is power.
46Kids and Terrorism
- Monitor the expert sources for new information
and products addressing the needs of children and
families in the WMD setting. - Pediatric Preparedness for Disasters and
Terrorism A National Consensus Conference,
Executive Summary - http//www.bt.cdc.gov/children/pdf/working/execsum
m03.pdf
47Additional Resources
- American Academy of Pediatrics http//www.aap.org/
terrorism/index.html - American Academy of Child and Adolescent
Psychiatry http//www.aacap.org/publications/Dis
asterResponse/index.htm - EMSC website www.ems-c.org
48Conclusions
- The cavalry may not come. Plan!
- We are all emergency planners and managers.
- Children are small but they can present their own
big issues in disaster preparedness. - Children and families need advocates at all
levels of disaster planning. - Planning should be family-centered, all hazards
based.
49Final thought
- Our ability to care for children in disasters
will never be better than our ability to care for
them on a daily basis.
50Thank you! Questions?
Louromig_at_bellsouth.net Louromig_at_jumpstarttriage.co
m Download lectures at www.jumpstarttriage.com